7/30/2019 DSM 5 Espectro Autista Dsm 5
1/61
Haga clic para modificar el estilo de subttulo del
patrn
2/09/11
Autism Spectrum Disorder,
ADHD, ODD and sluggish
cognitive tempo
DSM 5Dr. See King Emilio Quinto
Psiquiatra. CBT PhD. M.A. Terapia familiar y logoterapia.
CBT Training for children and adolescents Beck Institute.
USA:
Miembro Internacional de APAProfesor asociado os rado de si uiatra USAC
7/30/2019 DSM 5 Espectro Autista Dsm 5
2/61
2/09/11
Speaker: JanssenCilag, Astra Zeneca,Glaxo, Elli Lilly,
Organon, Pfizer,Abbott, Laprin,Asofarma, ABL.
Research: AstraZeneca, Elli Lilly,UCSF, UCLA.
Declaraciones de inters tico.
7/30/2019 DSM 5 Espectro Autista Dsm 5
3/61
2/09/11
Agenda.
Descripcin de los criterios de inclusinpropuestos.
Razones para el cambio.
Referencias bibliogrficas.
Casos clnicos.
7/30/2019 DSM 5 Espectro Autista Dsm 5
4/61
2/09/11
A 09 Autism Spectrum
Disorder Must meet criteria A, B, C, and D:
A. Persistent deficits in socialcommunication and social interactionacross contexts, not accounted for bygeneral developmental delays, and
manifest by all 3 of the following:
1. Deficits in social-emotionalreciprocity; ranging from abnormal social
approach and failure of normal back and
7/30/2019 DSM 5 Espectro Autista Dsm 5
5/61
2/09/11
A 09 Autism Spectrum
Disorder B. Restricted, repetitive patterns of
behavior, interests, or activities asmanifested by at least two of the
following: 1. Stereotyped or repetitive speech,
motor movements, or use of objects;
(such as simple motor stereotypies,echolalia, repetitive use of objects, oridiosyncratic phrases).
2. Excessive adherence to routines,
7/30/2019 DSM 5 Espectro Autista Dsm 5
6/61
2/09/11
A 09 Autism Spectrum
Disorder C. Symptoms must be present in early
childhood (but may not become fullymanifest until social demands exceed
limited capacities) D. Symptoms together limit and
impair everyday functioning.
7/30/2019 DSM 5 Espectro Autista Dsm 5
7/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
8/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
9/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
10/61
2/09/11
A 09 Autism Spectrum
Disorder: Razones de
cambio. New name for category, autism spectrum
disorder, which includes autistic disorder(autism), Aspergers disorder, childhood
disintegrative disorder, and pervasivedevelopmental disorder not otherwisespecified.
7/30/2019 DSM 5 Espectro Autista Dsm 5
11/61
2/09/11
A 09 Autism Spectrum
Disorder: Razones de
cambio. Differentiation of autism spectrum
disorder from typical development andother "nonspectrum" disorders is done
reliably and with validity; whiledistinctions among disorders have beenfound to be inconsistent over time,variable across sites and often associatedwith severity, language level or intelligencerather than features of the disorder.
7/30/2019 DSM 5 Espectro Autista Dsm 5
12/61
2/09/11
A 09 Autism Spectrum
Disorder: Razones de
cambio. Because autism is defined by a common
set of behaviors, it is best represented asa single diagnostic category that is
adapted to the individuals clinicalpresentation by inclusion of clinicalspecifiers (e.g., severity, verbal abilities andothers) and associated features (e.g.,known genetic disorders, epilepsy,intellectual disability and others.) A singlespectrum disorder is a better reflection
of the state of knowledge about
7/30/2019 DSM 5 Espectro Autista Dsm 5
13/61
2/09/11
A 09 Autism Spectrum
Disorder Razones de
cambio. Three domains become two:
1) Social/communication deficits
2) Fixated interests and repetitivebehaviors
7/30/2019 DSM 5 Espectro Autista Dsm 5
14/61
2/09/11
A 09 Autism Spectrum
Disorder Deficits in communication and social
behaviors are inseparable and moreaccurately considered as a single set of
symptoms with contextual andenvironmental specificities
Delays in language are not unique nor
universal in ASD and are more accuratelyconsidered as a factor that influences theclinical symptoms of ASD, rather thandefining the ASD diagnosis
7/30/2019 DSM 5 Espectro Autista Dsm 5
15/61
2/09/11
A 09 Autism Spectrum
Disorder Requiring both criteria to be completely
fulfilled improves specificity of diagnosiswithout impairing sensitivity
Providing examples for subdomains for arange of chronological ages and languagelevels increases sensitivity across severity
levels from mild to more severe, whilemaintaining specificity with just twodomains
Decision based on literature review,
7/30/2019 DSM 5 Espectro Autista Dsm 5
16/61
2/09/11
Several social/communication criteriawere merged and streamlined to clarifydiagnostic requirements.
In DSM-IV, multiple criteria assess samesymptom and therefore carry excessiveweight in making diagnosis
Merging social and communicationdomains requires new approach tocriteria
Secondary data analyses were conducted
7/30/2019 DSM 5 Espectro Autista Dsm 5
17/61
2/09/11
Severity Level for
ASD
Social Communication Restricted interests &
repetitive behaviors
Level 3
Requiring very substantial
support
Severe deficits in verbal
and nonverbal social
communication skills
cause severe impairments
in functioning; very limitedinitiation of social
interactions and minimal
response to social
overtures from others.
Preoccupations, fixated
rituals and/or repetitive
behaviors markedly
interfere with functioning
in all spheres. Markeddistress when rituals or
routines are interrupted;
very difficult to redirect
from fixated interest or
returns to it quickly.
7/30/2019 DSM 5 Espectro Autista Dsm 5
18/61
2/09/11
Severity Level for ASD Social Communication Restricted interests &
repetitive behaviors
Level 2
Requiring substantial
support
Marked deficits in verbal
and nonverbal social
communication skills;
social impairments
apparent even withsupports in place; limited
initiation of social
interactions and reduced
or abnormal response to
social overtures fromothers.
RRBs and/or
preoccupations or fixated
interests appear frequently
enough to be obvious to
the casual observer andinterfere with functioning
in a variety of contexts.
Distress or frustration is
apparent when RRBs are
interrupted; difficult toredirect from fixated
interest.
7/30/2019 DSM 5 Espectro Autista Dsm 5
19/61
2/09/11
Severity Level for ASD Social Communication Restricted interests &
repetitive behaviors
Level 1
Requiring support
Without supports in place,
deficits in social
communication causenoticeable impairments.
Has difficulty initiating
social interactions and
demonstrates clear
examples of atypical or
unsuccessful responses to
social overtures of
others. May appear to
have decreased interest in
social interactions.
Rituals and repetitive
behaviors (RRBs) cause
significant interferencewith functioning in one or
more contexts. Resists
attempts by others to
interrupt RRBs or to be
redirected from fixated
interest.
7/30/2019 DSM 5 Espectro Autista Dsm 5
20/61
Haga clic para modificar el estilo de subttulo del
patrn
2/09/11
A 10 Attention
Deficit/HyperactivityDisorder
7/30/2019 DSM 5 Espectro Autista Dsm 5
21/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder The disorder consists of a characteristic
pattern of behavior and cognitivefunctioning that is present in different
settings where it gives rise to social andeducational or work performancedifficulties. The manifestations of thedisorder and the difficulties that theycause are subject to gradual change beingtypically more marked during times whenthe person is studying or working and
lessening during vacation.
7/30/2019 DSM 5 Espectro Autista Dsm 5
22/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder Superimposed on these short-term
changes are trends that may signal somedeterioration or improvement with many
symptoms becoming less common inadolescence. Although irritable outburstsare common, abrupt changes in moodlasting for days or longer are notcharacteristic of ADHD and will usuallybe a manifestation of some other distinctdisorder.
7/30/2019 DSM 5 Espectro Autista Dsm 5
23/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder In children and young adolescents, the
diagnosis should be based on informationobtained from parents and teachers.
When direct teacher reports cannot beobtained, weight should be given toinformation provided to parents byteachers that describe the childs behaviorand performance at school. Examinationof the patient in the clinicians office mayor may not be informative. For older
adolescents and adults, confirmatory
7/30/2019 DSM 5 Espectro Autista Dsm 5
24/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
25/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
26/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder A. Either (1) and/or (2).
1. Inattention: Six (or more) of thefollowing symptoms have persisted for at
least 6 months to a degree that isinconsistent with developmental level andthat impact directly on social and
academic/occupational activities. Note:for older adolescents and adults (ages 17and older), only 4 symptoms are required.The symptoms are not due too ositional behavior, defiance, hostilit ,
7/30/2019 DSM 5 Espectro Autista Dsm 5
27/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder (c) Often does not seem to listen when
spoken to directly (mind seemselsewhere, even in the absence of any
obvious distraction). (d) Frequently does not follow through
on instructions (starts tasks but quickly
loses focus and is easily sidetracked, failsto finish schoolwork, household chores,or tasks in the workplace).
(e) Often has difficulty organizing tasks
7/30/2019 DSM 5 Espectro Autista Dsm 5
28/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder (g) Frequently loses objects necessary
for tasks or activities (e.g., schoolassignments, pencils, books, tools, wallets,
keys, paperwork, eyeglasses, or mobiletelephones).
(h) Is often easily distractedby
extraneous stimuli. (for older adolescentsand adults may include unrelatedthoughts.).
(i) Is often forgetful in daily activities,
7/30/2019 DSM 5 Espectro Autista Dsm 5
29/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder 2. Hyperactivity and Impulsivity: Six
(or more) of the following symptomshave persisted for at least 6 months to a
degree that is inconsistent withdevelopmental level and that impactdirectly on social andacademic/occupational activities. Note:for older adolescents and adults (ages 17and older), only 4 symptoms are required.The symptoms are not due to
oppositional behavior, defiance, hostility,
7/30/2019 DSM 5 Espectro Autista Dsm 5
30/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder (c) Often runs about or climbs on
furniture and moves excessively ininappropriate situations. In adolescents or
adults, may be limited to feeling restlessor confined.
(d) Is often excessively loudor noisy
during play, leisure, or social activities. (e) Is often on the go,acting as if
driven by a motor. Is uncomfortable
being still for an extended time, as in
7/30/2019 DSM 5 Espectro Autista Dsm 5
31/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder (g) Often blurts out an answerbefore a
question has been completed. Olderadolescents or adults may complete
peoples sentences and jump the gun inconversations.
(h) Has difficulty waiting his or her
turn or waiting in line. (i) Often interrupts or intrudes on
others (frequently butts into
conversations, games, or activities; may
7/30/2019 DSM 5 Espectro Autista Dsm 5
32/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder (k) Is often impatient, as shown byfeeling restless when waiting for othersand wanting to move faster than others,
wanting people to get to the point,speeding while driving, and cutting intotraffic to go faster than others.
(l) Is uncomfortable doing thingsslowly and systematicallyand oftenrushes through activities or tasks.
(m) Finds it difficult to resist
7/30/2019 DSM 5 Espectro Autista Dsm 5
33/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder B. Several noticeable inattentive orhyperactive-impulsive symptoms werepresent by age 12.
C. The symptoms are apparent in twoor more settings (e.g., at home, school orwork, with friends or relatives, or in other
activities). D. There must be clear evidence that the
symptoms interfere with or reduce the
quality of social, academic, or
7/30/2019 DSM 5 Espectro Autista Dsm 5
34/61
2/09/11
A 10 Attention
Deficit/Hyperactivity
Disorder E. The symptoms do not occurexclusively during the course ofschizophrenia or another psychotic
disorder and are not better accountedfor by another mental disorder (e.g.,mood disorder, anxiety disorder,dissociative disorder, or a personalitydisorder).
7/30/2019 DSM 5 Espectro Autista Dsm 5
35/61
2/09/11
Specify Based on Current
Presentation Combined Presentation: If both
Criterion A1 (Inattention) and CriterionA2 (Hyperactivity-Impulsivity) are met for
the past 6 months. Predominately Inattentive
Presentation: If Criterion A1
(Inattention) is met but Criterion A2(Hyperactivity-Impulsivity) is not met and3 or more symptoms from Criterion A2have been present for the past 6 months.
7/30/2019 DSM 5 Espectro Autista Dsm 5
36/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
37/61
Haga clic para modificar el estilo de subttulo del
patrn
2/09/11
Q 00 Oppositional Defiant
Disorder
7/30/2019 DSM 5 Espectro Autista Dsm 5
38/61
2/09/11
Q 00 Oppositional Defiant
Disorder A. A persistent pattern of angry and
irritable mood along with defiant andvindictive behavior as evidenced by four
(or more) of the following symptomsbeing displayed with one or more personsother than siblings.
Angry/Irritable Mood 1. Loses temper
2. Is touchy or easily annoyed by others.
3. Is an r and resentful
7/30/2019 DSM 5 Espectro Autista Dsm 5
39/61
2/09/11
Q 00 Oppositional Defiant
Disorder Defiant/Headstrong Behavior
4. Argues with adults
5. Actively defies or refuses to complywith adults request or rules
6. Deliberately annoys people
7. Blames others for his or her mistakesor misbehavior
7/30/2019 DSM 5 Espectro Autista Dsm 5
40/61
2/09/11
Q 00 Oppositional Defiant
Disorder Vindictiveness
8. Has been spiteful or vindictive at leasttwice within the past six months
7/30/2019 DSM 5 Espectro Autista Dsm 5
41/61
2/09/11
Q 00 Oppositional Defiant
Disorder B. (NOTE: UNDER CONSIDERATION)
The persistence and frequency of thesebehaviors should be used to distinguish a
behavior that is within normal limits froma behavior that is symptomatic todetermine if they should be considered asymptom of the disorder. For childrenunder 5 years of age, the behavior mustoccur on most days for a period of atleast six months unless otherwise noted
(see symptom #8). For individuals 5 years
7/30/2019 DSM 5 Espectro Autista Dsm 5
42/61
2/09/11
Q 00 Oppositional Defiant
Disorder C. The disturbance in behavior causes
clinically significant impairment in social,educational, or vocational activities.
D. The behaviors may be confined to onlyone setting or in more severe casespresent in multiple settings.
7/30/2019 DSM 5 Espectro Autista Dsm 5
43/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
44/61
2/09/11
Recomendaciones y razonespara el cambio 1. Do not make major changes to
the symptoms or structure of the
ODD criteria.
2. Remove exclusionary criteria forConduct Disorder.
3. Organize symptoms in the
criteria for ODD to distinguishemotional and behavioral
symptoms.
7/30/2019 DSM 5 Espectro Autista Dsm 5
45/61
2/09/11
Recomendaciones y razonespara el cambio 4. Develop a severity index based on
the cross-situation pervasiveness of
the symptoms.
Under consideration: Provideobjective and standard definitions of
frequency for ODD symptom
threshold.
7/30/2019 DSM 5 Espectro Autista Dsm 5
46/61
2/09/11
0 - Absent: Shows fewer than twosymptoms
1 - Subthreshold: Shows at least two
but fewer than four symptoms orsymptoms do not cause significantimpairment in any setting 2 -
Mild: Shows at least four symptoms butsymptoms are confined to only onesetting (e.g., at home, at school, at work,with peers)
7/30/2019 DSM 5 Espectro Autista Dsm 5
47/61
2/09/11
Sluggish cognitive tempo
Is an unformalized descriptive term whichis used to better identify what appears tobe a homogeneous sub-subgroup within
the formal subgroup "ADHDpredominantly inattentive(ADHD-I orADHD-PI).
7/30/2019 DSM 5 Espectro Autista Dsm 5
48/61
2/09/11
SCT
Have the opposite symptoms of thosewith classic ADHD: instead of beinghyperactive, extroverted, obtrusive, and
risk takers, those with SCT are drifting,introspective and daydreamy, and feel as if"in the fog" (although in excited states, anSCT patient behaves very similarly to a
traditional ADHD patient).
7/30/2019 DSM 5 Espectro Autista Dsm 5
49/61
2/09/11
SCT
A key behavioral characteristic of thosewith SCT symptoms is that they are morelikely to appear to be lacking motivation.
They lack energy to deal with mundanetasks and will consequently seek thingsthat are mentally stimulating because oftheir underaroused state, an intense
craving for emotional and intellectualstimulation.
7/30/2019 DSM 5 Espectro Autista Dsm 5
50/61
2/09/11
SCT
Currently the American PsychiatricAssociation (APA) is working on creatingthe DSM-5. In the published preliminary
draft revisions, APA writes that moreresearch is needed to assess the "sluggishcognitive tempo" construct
7/30/2019 DSM 5 Espectro Autista Dsm 5
51/61
2/09/11
7/30/2019 DSM 5 Espectro Autista Dsm 5
52/61
2/09/11
Caso clnico.
Nace en Praga 1883. Fue un escritor checo de idioma alemn.
Su obra es considerada una de las ms
influyentes de la literatura universal en elltimo siglo,1 a pesar de no ser muyextensa: fue autor de tres novelas(El
proceso, El castillo yAmrica), una novelacorta(La metamorfosis) y un ciertonmero de parbolas y relatos breves.
http://es.wikipedia.org/wiki/Franz_Kafkahttp://es.wikipedia.org/wiki/Franz_Kafka7/30/2019 DSM 5 Espectro Autista Dsm 5
53/61
2/09/11
Caso clnico
Padre autoritario, madre pasiva. Era el mayor de seis hermanos. Dos de
ellos, Georg y Heinrich, fallecieron a los
quince y seis meses de edad. Por cuya muerte se sinti culpable en
cierto sentido al vincularla con sus deseos
de que desapareciesen motivados por suscelos.
7/30/2019 DSM 5 Espectro Autista Dsm 5
54/61
2/09/11
Caso clnico.
En sus relaciones sociales, albergabatemor de ser percibido de manerarepulsiva tanto fsica como mentalmente.
Muy al contrario, impresionaba a losdems con su aspecto infantil, pulcro yaustero, su conducta tranquila y fra, y sugran inteligencia, adems de su particular
sentido del humor. Desde 1905 se veobligado a frecuentar los sanatorios comoresultado de su debilidad fsica.
7/30/2019 DSM 5 Espectro Autista Dsm 5
55/61
2/09/11
Caso clnico
Entre 1913 y 1917 mantuvo una relacinde dimensiones muy complejas conFelice Bauer, que dio origen a una
correspondencia de ms de 500 cartas ytarjetas postales.
7/30/2019 DSM 5 Espectro Autista Dsm 5
56/61
2/09/11
Caso clnico
En sus diarios y cartas se quejafrecuentemente de insomnio y dolores decabeza. Fue un partidario de la dieta
vegetariana y del naturismo. Se dice queconsuma grandes cantidades de leche sinpasteurizar, lo que pudo ser el factordesencadenante de su tuberculosis, en
1917, en sus cuadernos ntimos l hablade "demonios", "derrumbamiento","embates", "desamparo", "persecucin",
"soledad", "asalto a las ltimas fronteras
7/30/2019 DSM 5 Espectro Autista Dsm 5
57/61
2/09/11
Caso clnico
Slo public algunas historias cortasdurante toda su vida, una pequea partede su trabajo, por lo que su obra pas
prcticamente inadvertida hasta despusde su muerte. Con anterioridad a sufallecimiento, dio instrucciones a su amigoy albacea Max Brod de que destruyera
todos sus manuscritos.
7/30/2019 DSM 5 Espectro Autista Dsm 5
58/61
2/09/11
Caso clnico
En su obra, a menudo el protagonista seenfrenta a un mundo complejo, que sebasa en reglas desconocidas, las cuales
nunca llega a comprender. El adjetivokafkiano se utiliza precisamente a menudopara describir situaciones similares
7/30/2019 DSM 5 Espectro Autista Dsm 5
59/61
2/09/11
Caso clnico
Frank Kafka.
20 id A 0 49Vi t H II 15
7/30/2019 DSM 5 Espectro Autista Dsm 5
60/61
2/09/11
20 avenida A 0-49 Vista Hermosa II zona 15Guatemala ciudad.
[email protected] Telfonos:(502) 23690709 y(502)23693238
www.clinicahumanamente.com
Cursos y seminarios.
Entrenamiento intensivo clnico.
Atencin psiquitrica. Publicaciones.
Investigaciones.
7/30/2019 DSM 5 Espectro Autista Dsm 5
61/61
PUBLICACIONES
Top Related